The 4:30 pm nurse was leaving and I was inheriting her patient since I was scheduled until 5:30 pm.
I had been watching the patient’s story unfold since he came into PACU. He was crying when he came into the recovery room. Almost a growling noise. The nurse was talking to him in a loud firm voice telling him to open his eyes and make eye contact. He told her to leave him alone as he swung his arm. He wasn’t awake, but he was not asleep either. She kept after him to use his words and open his eyes. Did I mention he was a MAN not a 3 year old. With his head buried under the blankets he swore at her. She got closer to his face. I was waiting for his fist to slide from under the blanket and punch her right in the smacker. She told him that he was in a public place and that he should not swear. Did he know what he was saying? I don’t think so. He cried out that it hurt. That surely sounded like he was using his “words” then.
I was disturbed by this scene. It appeared that his behavior was escalating. Either he was messed up before surgery or the surgery triggered something in him. His yelling/moaning/swearing was truly bothering other patients and ME. A medication called Versed should be considered. Versed creates an amnesia like affect. Versed could give him a fresh start in the recovery room. His traumatic wake up might be subdued…..less violent and upset. If anyone needed special nursing care it was this patient.
Of course his nurse knew this and the medication was given prior to me taking over. He was sleeping on his side turned away from me. He could not tolerate any part of the monitor being attached. I had to watch him in a way that he didn’t feel threatened. It was nearly impossible to check the dressings on his tummy, but I did check them. I had to….his safety was at stake. It was my job to keep him safe in spite of himself. Without opening his eyes he yelled at me, calling me a liar, when I managed to sneak a peak under the blanket. Incision sites were all intact. The girlfriend was sitting beside him stroking his head. She had a calming affect on him. The situation was looking better.
30 minutes. He would sleep. Wake up suddenly. Breathing hard in a panicky way asking why he was in jail and saying to no one in particular, “don’t let those cops near me”. He was not oriented. Then things changed. He actually looked at his girlfriend and recognized her. She told him that he was in the hospital, he had surgery, and now he was in the recovery room. She got through to him. I had to talk to him through her. He clung onto her. Not looking at me. I tried to reattach the monitor, but he pushed my hand away. I could not force him to do anything. It was like walking on a mountain ridge with drop offs on either side. He was slipping in and out of orientation.
Up until this point he pushed offers of water or ice chips away. His girlfriend kept offering the water over and over. Finally a tiny taste of water touched his lips and he drank and drank. Closing his eyes drinking. He kept asking me what did he do wrong. Why was he in jail. I reassured him that he did nothing wrong. He was safe. No one was going to arrest him. He wasn’t pushing me away. I rubbed his back as he drank. Was he trusting me? Still no eye contact with me, but he did look at his girlfriend. He let me rub his back for a few minutes. “You didn’t do anything wrong. You had hernia surgery. You’re in the hospital. You are safe. You didn’t do anything wrong. No one is going to arrest you”, I repeated to him as many times as it took.
All of a sudden he said he wanted to go home. He started to climb out of bed. The side railings were not going to contain him for long. Things moved very fast now.
Haggle time. He wants to go home. I need some numbers to confirm that he was alright. “If you let me put this on your finger I will let you get put your shirt on”, I bargained. Deal. Oxygen saturation within normal limits. Shirt on. If you let me take your temperature you can put your pants on and so it went. Pretty soon I had my numbers and he was almost dressed. IV out. Positively no way would he put his shoes on. Hey it’s summer! Paper booties on his feet were acceptable. He’s standing up, dressed, he was oriented to person, place and time. No go on the wheel chair. He became a little combative about that idea. Security called. He flipped out when he saw them.
“COPS”, he yelled. His anxiety increasing rapidly. “You lied to me”, he said.
Security tried to calm him which made him worse. He was steady on his feet and moving fast. The girlfriend and I walked with him right to the front lobby….right outside. I was fearful that I wouldn’t be able to stop him from bolting into traffic. I knew security was watching. It took forever for his ride to pull up. He insisted that his girlfriend sit in the front of the car. What? Is he showing some chivalry. No. He’s showing paranoid schizophrenia. He wanted to sit in the back to keep his eyes on everyone and everything going on.
He was a non medicated paranoid schizophrenic person….on a bad trip triggered by the surgery. He was back to his baseline and he’s out there.
TIDBIT Schizophrenia had not been a diagnosis during Florence’s time. However that does not mean it didn’t exist. Mental illness was referred to as Madness. Anyone who was “off”, deformed or mentally retarded were clumped into one group. Their demented or confused behavior was associated with evil spirits. One treatment was to drill holes in the heads of people who suffered from “Madness” to let the evil spirits out. Ouch.